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Advocacy Award

This award recognizes individuals, organizations or companies that step up to represent the industry and its patients by being advocates through education and outreach to state or national level decision makers. Nominees do not have to be UCAOA Members.

Before completing the form, please ensure that the nominee meets the following criteria:

Nominee has significantly contributed to some local, state, or federal outreach to advocate urgent care centers as a whole

Nominee must prove advocacy and support efforts through petitions, media and press, etc.

Who do you nominate for this award *Write the first and last name of the person you would like to nominate for the Advocacy Award. If you want to nominate an organization please write the organization name.

Why does the nominee deserve the award? *Explain why the nominee deserves the Advocacy Award. Please include how this candidate meets the criteria needed for this award. You may also attach documents, photos, and links in the next field.

Attachments Please upload any photos or documents helpful to the selection process. Photos may be used in future marketing and presentation of awards.

Nominee Phone *

Nominee Email Address *

Nominator Name *If you are the nominator please enter your first and last name. If this is a self nomination, please write self into the field.

Nominator Phone *

Nominator Email Address *

Reference Name *Please write down at least one reference who can provide additional information regarding the nomination.